Provider Demographics
NPI:1336252790
Name:COHEN, SANDRA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:S
Last Name:COHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NORMANSKILL BLVD
Mailing Address - Street 2:STE 402
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1335
Mailing Address - Country:US
Mailing Address - Phone:518-439-8442
Mailing Address - Fax:518-463-0340
Practice Address - Street 1:4 NORMANSKILL BLVD
Practice Address - Street 2:STE 402
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1335
Practice Address - Country:US
Practice Address - Phone:518-439-8442
Practice Address - Fax:518-463-0340
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02984111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC4005Medicare ID - Type Unspecified
P22609Medicare UPIN